Annuloplasty procedures, related devices and methods

Abstract

Devices and methods are disclosed for the treatment or repair of regurgitant cardiac valves, such as a mitral valve. An illustrative annuloplasty device can be placed in the coronary sinus to reshape the mitral valve and reduce mitral valve regurgitation. The disclosure also provides improved techniques for cardiac pacing.

The invention claimed is: 
     
       1. A cutting catheter, comprising:
 a) an elongate inner member having a proximal end and a distal end with a distally facing blade mounted on the distal end; and 
 b) an elongate outer tubular member having a proximal end, a distal end and defining an elongate lumen therethrough for slidably receiving the elongate inner tubular member therein, wherein the elongate outer tubular member defines a pair of laterally offset holes therethrough near the blade for receiving a suture material therethrough, wherein distal advancement of the elongate inner member with respect to the elongate outer tubular member passes the blade past the suture to cut the suture, wherein the distally facing blade is configured to slide within a flattened distal portion of the elongate outer tubular member. 
 
     
     
       2. The cutting catheter of  claim 1 , wherein the distal end of the elongate outer tubular member is rounded and atraumatic. 
     
     
       3. The cutting catheter of  claim 1 , wherein the pair of holes includes two axially spaced apart holes defined through a distal end region of the cutting catheter, wherein a distal hole of the pair of holes accepts a suture therethrough as an entrance port, and a proximal hole of the pair of holes provides an exit port for the suture. 
     
     
       4. The cutting catheter of  claim 1 , further comprising a proximal handle having a spring loaded push button trigger, wherein the push button trigger is coupled to the elongate inner member. 
     
     
       5. The cutting catheter of  claim 4 , wherein the distally facing blade advances distally past the openings when the trigger is depressed. 
     
     
       6. The cutting catheter of  claim 1 , wherein the distally facing blade is “V” shaped, and the distally facing blade is configured to capture a suture in an apex of the distally facing blade, wherein the suture passes through the pair of holes. 
     
     
       7. A cutting catheter, comprising:
 a) an elongate inner member having a proximal end and a distal end with a distally facing blade mounted on the distal end; 
 b) an elongate outer tubular member having a proximal end, a distal end and defining an elongate lumen therethrough for slidably receiving the elongate inner tubular member therein, wherein the elongate outer tubular member defines first and second holes on first and second opposing sides of a distal end region of the elongate outer tubular member, wherein a suture passing through the distal end region of the cutting catheter can be used as a guide rail to slide the distal end region of the cutting catheter percutaneously through a patient's vasculature to an target location near the patient's heart; and 
 c) a proximal handle including an actuator having a push-button trigger that is movably disposed with respect to the proximal handle, the actuator being coupled to the elongate inner member, wherein actuating the actuator causes the distally facing blade to move distally past at least one of the first hole and the second hole. 
 
     
     
       8. The cutting catheter of  claim 7 , wherein the distally facing blade is “V” shaped, and to cause the distally facing blade to capture a suture in an apex of the distally facing blade, wherein the suture passes through the first and second openings. 
     
     
       9. A method of using the cutting catheter of  claim 7 , including, threading an elongate member to be severed that extends outside of a patient through the first and second holes of the cutting catheter, introducing the distal end region of the cutting catheter over the elongate member into the vasculature of the patient, advancing the catheter to a target location within the patient's vasculature, and advancing the blade distally with respect to the outer tubular member to sever the elongate member. 
     
     
       10. A method of using the cutting catheter of  claim 7 , including threading a proximal end of a cardiac lead coupled to an anchoring point inside a patient's vasculature through the first and second holes of the cutting catheter, introducing the distal end region of the cutting catheter over the cardiac lead into the vasculature of the patient, advancing the catheter to a target location within the patient's vasculature near the anchoring point, and advancing the blade distally with respect to the outer tubular member to sever the cardiac lead. 
     
     
       11. The cutting catheter of  claim 7 , wherein the distal end of the elongate outer tubular member is rounded and atraumatic. 
     
     
       12. The cutting catheter of  claim 7 , wherein the first and second holes includes two axially spaced apart holes defined through a distal end region of the cutting catheter, wherein a distal hole of first and second holes accepts a suture therethrough as an entrance port, and a proximal hole of the first and second holes provides an exit port for the suture. 
     
     
       13. The cutting catheter of  claim 7 , wherein the distally facing blade advances distally past the first and second holes when the actuator is actuated. 
     
     
       14. A cutting catheter, comprising:
 an elongate inner member having a proximal end and a distal end with a distally facing blade mounted on the distal end; and 
 an elongate outer tubular member having a proximal end, a distal end and defining an elongate lumen therethrough for slidably receiving the elongate inner tubular member therein, wherein the elongate outer tubular member defines first and second holes on first and second opposing sides of a distal end region of the elongate outer tubular member; and 
 a loading snare directed through the first and second holes to receive an elongate member to be pulled through the first and second holes to load the cutting catheter, 
 
       tubular member is rounded and atraumatic. 
     
     
       15. The cutting catheter of  claim 14 , wherein the distal end of the elongate outer tubular member is rounded and atraumatic. 
     
     
       16. The cutting catheter of  claim 14 , wherein the first and second holes include two axially spaced apart holes defined through a distal end region of the cutting catheter, wherein a distal hole of the first and second holes accepts a suture therethrough as an entrance port, and a proximal hole of the first and second holes provides an exit port for the suture. 
     
     
       17. The cutting catheter of  claim 14 , wherein the distally facing blade is “V” shaped, and the distally facing blade is configured to capture a suture in an apex of the distally facing blade, wherein the suture passes through the pair of holes.